Remote Jobs at Wellsense Health Plan

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. Job Summary: The Appeals and Grievances BH Quality Nurse ensures clinically appropriate and compliant appeals and grievances decisions through appeals and grievances audits, responsibility for regulatory reporting and universe preparation, and regulatory audit support and presentation. The Appeals and Grievances BH Quality Nurse focuses on improving the quality of care for members with behavioral health and substance use needs. The Appeals and Grievances BH Quality Nurse is responsible for clinical support of all clinical appeals and grievance activities. The Appeals and Grievances BH Quality Nurse collaborates with other Appeals and Grievances Quality Nurses, Member Appeals and Grievances Specialists, Program Coordinators, as well as other business partners across the organ ...